Healthcare Provider Details

I. General information

NPI: 1609907344
Provider Name (Legal Business Name): COMPREHENSIVE CENTER FOR WOMENS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E DELAWARE PL 501
CHICAGO IL
60611-1449
US

IV. Provider business mailing address

1 E DELAWARE PL 501
CHICAGO IL
60611-1449
US

V. Phone/Fax

Practice location:
  • Phone: 773-435-1150
  • Fax: 773-435-1330
Mailing address:
  • Phone: 773-435-1150
  • Fax: 773-435-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTINA S COCKERILL
Title or Position: PRACTICE ADMINISTRATOR
Credential: CPA
Phone: 773-435-1150